How can we ‘end malaria for good’ if we cannot identify it?

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The theme for the 2016 World Malaria Day, ‘end malaria for good’, presents us with a double challenge.1 We want to end malaria finally, or eliminate it between 2030 and 2040, but also, ending it will be good for saving lives and improving economies of endemic countries. The challenge arises when we consider whether we will have adequate resources to accomplish the task. As colleagues from the University of California in San Francisco observed, ‘Sustaining domestic and international funding as malaria burden decreases is a serious concern for most of the eliminating countries’.2

One way to guarantee resources is through conserving what we have and only treating people for malaria when they actually have the disease, and not some other febrile illness. The advent of malaria rapid diagnostic tests (mRDTs) that can be used at the primary care level, including within the community should have improved our ability to differentiate malaria from other causes of fever.3 Unfortunately, mRDTs do not always guide correct case management.4–6 When a febrile patient tests negative, we may not have the ability to do further differential diagnosis. Some causes of fever do not have a direct cure. Therefore if malaria drugs are available through programmes like The Global Fund, we are tempted to use them since many front-line clinicians feel that, ‘We must do something for the patient’.